Using willpower to change a behavior means working hard to achieve something; Merriam Webster defines will power as “energetic determination.” If I need willpower to accomplish something, then I am attempting a task that I feel some level of conflict about doing.

Like part of me knows I need or should do something, but another part of me feels resistance to doing it.

For a person who has completely decided, once and for all, to stop using drugs or drinking or smoking cigarettes, and they have done the deep work around quitting, no willpower is necessary. When the choice to use is no longer an option, resistance drops.

Perhaps the most important part of getting to this place of diminished resistance is creating an environment conducive to succeeding.

This week I put a 3rd naltrexone implant in my patient, Slim (not his real name). Slim has just over a year off of fentanyl-laced heroin. He has spent six of his 37 years behind bars for crimes directly related to his addiction. He never wants to be inside a jail again.

He tells me that in earlier attempts to get off opioids he tried to remain loyal to his old friends who were actively using. These were friends he spent his childhood with and was related to many of them. With extraordinary willpower, he was able to stick to his decision not to use when he was with them for brief periods of time. But when stress was high, the feeling of deprivation was overwhelming, and willpower waned, he invariably relapsed.

During his last stint in prison, he worked in earnest on his sobriety. He went to every meeting that was offered and took advantage of one-on-one time with sober leaders. He made it a point to hang out with clean guys as much as possible. He read recovery literature. Even given the constraints of being in prison, he found ways to change his environment. He said that as soon as he started keeping the commitment to himself, he was rarely bothered by other prisoners to buy drugs.

He says eventually, “It was kind of like I was wearing a new set of glasses, and the only things I could see were things associated with being clean. Like everything else was filtered out. My brain felt peaceful. It was weird—but wonderful.”

The most important thing he learned during this time was the importance of changing who he hung out with on the outside. (Changing his environment) He made plans to meet up with the people who brought meetings to the prison when he was released. He made and kept a promise to himself not to contact old friends that might still be using.

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He agreed to come every two months to the Coleman Institute for Addiction Medicine to get a naltrexone implant.

Naltrexone is a pure opioid blocker that does not cause physical dependence, unlike some other medication-assisted treatments (MAT), such as buprenorphine or methadone. The small implant, about the size of a vitamin pill, goes under the skin in the abdominal area and lasts for about two months, sharply reducing physical cravings.

The implant works for people who are not only stopping drugs like heroin, but also for pain medications such as fentanyl, Percocet®, Vicodin®, Oxycontin®, and other variations of oxycodone and hydrocodone. (It is also extremely effective for blocking alcohol cravings). Using naltrexone therapy has been the focus of treatment at the Coleman Institute for over twenty years.

Slim is convinced that the secret of his successful recovery this time is that he changed his environment to support his vision of the man he wants to be, the man he is, and the man he is becoming.

He remains highly motivated, and it is paying off for him in all areas of his life.

He was recently promoted at his job. His children love that their dad is hanging out with them, attending their sports events, and helping them with homework. His fiancé — pregnant with their first child together — has a new level of trust for this man she loves. But perhaps the most touching testimony this (six-two, 220 pounds) man gives is when he talks about his mother and the pride and gratitude she feels, having her son back. Slim talked about this as I placed his implant, and there wasn’t a dry eye in the room, including Slim’s. (No worries, I could still see what I was doing :).)

As Benjamin Hardy, author of Willpower Doesn’t Work says, “ If you remain in an environment conflicting with your personal rules, you have only two choices: Conform to a bad environment or battle it through willpower. Both of these are very poor options and ultimately lead to the same place.”

I hope you will allow us to be a part of creating the best possible environment for you or your loved one. A life of recovery is waiting for you.

Joan R. Shepherd, FNP

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